In order to create the conditions that allow for health and well-being for all people in the US, we must boldly address the causal relationship between racism, discrimination, bias and poor health.3,4,5,6,7 As a medical anthropologist, I must clearly state that race is not a biological fact, but instead is socially constructed. Having satisfied that disciplinary requirement, let me be even clearer—an individual’s lived experience in the world from birth to death is shaped by the color of their skin (as so hauntingly illustrated in the “Strange Fruit” lyrics above). Over the past year, there has been a seemingly endless stream of media images2 of black people being killed or brutalized: Trayvon Martin, Michael Brown, Walter Scott, Eric Garner, Freddie Gray, Tamir Rice, Renisha McBride, and the Emanuel Nine. The images starkly illuminate the profound relationship between racism and black people’s health. Unfortunately, these events are not new nor are they anomalies in the US, but they have captured national attention. The hidden subtext of these events is the extent to which racist social interactions and institutional structures affect the daily lives of millions whose suffering is not broadcast on the nightly news.

Image Description: an individual is holding a sign above their head that reads, “We revolt simply because, for many reasons, we can no longer breathe.” Image Source: fuseboxradio on Flickr

A growing body of literature highlights the ways in which racism and discrimination affect the health status of people of color.3,4,5The American Journal of Public Health6 and the DuBois Review: Social Science Research on Race7 devoted entire issues to those concerns. Note a few examples. Persistent discrimination in housing and mortgage lending effectively sustain residential segregation which in turn restricts access to educational and employment opportunities, nutritious food, safe spaces to exercise, and high-quality medical care.8 The widening wealth gap—for every dollar of wealth held by white households, black households held 6 cents, and Latino households 7 cents.9,10 Research has shown that black people, when compared to whites, are less likely to be offered the latest health care treatments for cancer,11heart disease,12 and depression.13 Studies also reveal significant bias in the criminal justice system, leading to higher arrest, conviction, and incarceration14 rates for black people for similar crimes and at higher rates than whites. Data indicate that self-reported incidents of discrimination are psychosocial stressors that negatively affect physical and mental health.13,16 In sum, racism is a public health problem.15,16,17,18,19 It contributes to higher levels of stress, greater exposure to risk factors, reduced access to medical and social services, and ultimately to excess levels of disease, disability, and death.5

So, whose lives matter? Georges Benjamin, Executive Director of the American Public Health Association argues that “good intentions and good science are no longer enough”.20 Public health has the capacity, the tools, and the knowledge to connect and act on the ways in which racism and discrimination in all their forms become personified and observable as health inequities.21 Essential to the mission of public health is the capacity to analyze and promote social justice and health equity and inform the interconnected call for social justice, racial justice, economic justice, environmental justice, community justice, and climate justice.17,22

We are perhaps at an inflection point. Unlawful police killings, exemption, and health inequities are not new phenomena, nor is the related struggle to counter them.17 Public outrage and the cries for social justice demand that we move beyond antiseptic bromides about “diversity,” “cultural competency,” and the inane claim that we live in a “post-racial” society. Such a move requires accountability, open discussion, and candid self-assessment, of individuals and of our institutions, about the complex realities of racial injustice and the resulting historical trauma.20 The ability to unpack and forthrightly address the causal relationship of racism and discrimination to disease, disability and death is part of the charge and responsibility of public health programs. Equally, it is incumbent on medical schools to transmit that knowledge to future practicing physicians and public health experts and prepare them to address racially generated contemporary public health issues.15

Image Description: A person speaking at a podium is surrounded by a crowd of people, some of whom are holding signs that read “I Can’t Breathe,” “Hands Up Don’t Shoot,” and “Black Lives Matter.” Image Source: fuseboxradio on Flickr

If we want to truly achieve social justice and health equity, these recent high-profile incidents, and the rising social movement,23,24,25 might create an opportunity to confront and acknowledge the racist, discriminatory, and biased legacy of our history. To that end, we must be ready and willing to dismantle the systems that perpetuate inequality.20 The time to achieve these aims is now, and if not now, then when?

Karen Kelly-Blake, PhD, is an Assistant Professor in the Center for Ethics and Humanities in the Life Sciences and the Department of Medicine at Michigan State University.

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12 Responses to Racism and the Public’s Health: Whose Lives Matter?

Karen, thank you for this strong and very necessary blogpost, sadly in the wake of the violent death of yet another Black woman, Sandra Bland. I have recently read that an important health consequence of systemic racism in the U.S. is the increase of PTSD related to racially targeted violence, specifically in Black communities. This is not surprising, but it adds to the growing list of reasons why this needs to be a very high priority not only at the political level, but also for every organization and individual who provides services to the Black community, including healthcare providers.

Monica, thank you for your thoughtful comment and call to action. This is definitely a high priority issue, and will require us to engage in some very uncomfortable, and potentially hostile conversations about the legacy and harm of systemic racism in this country. Much has been achieved, but much work remains. We must be willing to do the work.

Karen, thank you for this. I have observed with great interest in teaching health disparities related material to first-year medical students the general tendency to presume the differences in health outcomes were primarily due either to 1) access to health care services or 2) variation in the incidence of health behaviors like smoking across different racial or ethnic groups. We have used journal articles about unconscious bias, patient narratives, and work like ‘In Sickness and in Wealth’ to try to expand the knowledge base on this amongst students, as well as discussion prompts regarding the possibility that interventions outside of the traditional bounds of “medicine” may be more powerful ways to address health, but there is clearly much more to be done. What do you see as the next educational opportunities for medical schools?

Robin, thank you for your question. Briefly, the next educational opportunity for medical schools, along with public health programs, is to call out and to teach about the everyday racist framing and structured in practices of historically white controlled medical, public health, and research funding institutions. The training of future physicians has to move beyond “cultural competency” and focus on directly naming the racist framing, discrimination, and biased attitudes found in medical and public health practice. I do think the new Shared Discovery Curriculum could offer us the opportunity to be at the forefront in directly conceptualizing and focusing on these issues by exposing students early to the lived experiences of patients.

Another sad fact showing how much Black lives matter is the amount of National Cancer Institute funding for stomach cancer (the cancer with the highest rate of excess Black over White deaths) vs. melanoma (the cancer with the highest rate of excess White over Black deaths). The rate of stomach cancer among Blacks is two thirds higher than that among Whites. The rate of melanoma in Whites is 6 times that among Blacks. In 2014, there were 10,990 deaths from stomach cancer and 9,710 for melanoma. NIH Research funding (2012) per death for stomach cancer $1,102. Funding per melanoma death $12,785. (Stomach cancer deaths among Hispanics and American Indians/Alaskan Natives is also similarly higher than among Whites.)

By this measure White lives are counted as being worth 10 times as much as Black lives.

Of course, this is only one potential disparity that we could look at, and in some ways, it might even be misleading. But, still, it is thought provoking, as well as disturbing.

Disturbing, but not surprising. The NIH, a historically white-run, and white-oriented institution has done much to improve health research, BUT only in 2010 was a Minority Health and Health Disparities Research Center created, and it, like other institutes engaging in disparities research, remains critically underfunded. The data you present on stomach cancer buttresses my call to answer the question: whose lives matter? Thank you very much for your insightful comments.

Has MSU as a whole considered approaching local area law enforcement agencies to partner in developing effective policies which address these issues? Regardless of whether they may deny such issues exist within the Lansing metropolitan area, the law enforcement agencies would benefit from such a partnership to ensure regular awareness on their part.

An excellent suggestion! I, personally, do not know of any such partnership. Considering the recent indictment of a University of Cincinnati police officer in the shooting of Samuel Dubose, developing a collaboration would be beneficial for our whole community. If you become aware of any such work in the future, please let me know. Thank you very much for taking the time to comment.